Department of Gastroenterology, The Henry Wellcome Laboratory, Institute of Translational Medicine, University of Liverpool, Nuffield Building, Crown Street, Liverpool L69 3GE, UK.
Therap Adv Gastroenterol. 2013 Jan;6(1):33-8. doi: 10.1177/1756283X12461395.
Steroids have been a mainstay of ulcerative colitis (UC) therapy for many years, based on a thoroughly established efficacy profile for the induction of remission. However, in light of the considerable side effects and negative perceptions they carry, it is important to ensure such treatments are used as effectively as possible. For severe UC, the need for steroids is rarely questioned, and rightly so; it is for moderate UC that the role of steroids should be considered. Both patients and clinicians place a high importance on rapid, effective resolution of symptoms, yet at the same time wish to avoid unnecessary side effects. Through consideration of the available evidence, it becomes clear that both steroids and high-dose 5-aminosalicylic acid (5-ASA) are supported by robust trials demonstrating their efficacy. Indeed, both therapies have been shown to give rise to resolution of symptoms after 2 weeks in many patients. However, a paucity of head-to-head comparisons makes conclusive interpretation challenging. This paper therefore presents a practical approach, which builds on the available evidence and is developed from informed discussions with patients. This approach involves initiating therapy with high-dose 5-ASA, followed by a review of symptom improvements after 2-3 weeks. Steroids can then be introduced, when needed, with minimal delay. In this way, symptoms can be resolved rapidly, yet many patients may avoid unpleasant side effects.
类固醇已被广泛用于溃疡性结肠炎（UC）治疗多年，这主要基于其在诱导缓解方面的疗效。然而，鉴于其存在相当大的副作用和负面影响，确保这些治疗方法得到尽可能有效的应用至关重要。对于重度 UC，类固醇的需求很少受到质疑，这是正确的；对于中度 UC，应考虑使用类固醇。患者和临床医生都非常重视症状的快速、有效缓解，但同时希望避免不必要的副作用。通过对现有证据的考虑，很明显，类固醇和高剂量 5-氨基水杨酸（5-ASA）都得到了强有力的试验的支持，这些试验证明了它们的疗效。事实上，这两种治疗方法都在许多患者中显示出在 2 周后症状得到缓解。然而，由于缺乏头对头比较，使得结论解释具有挑战性。因此，本文提出了一种实用的方法，该方法基于现有证据，并通过与患者的知情讨论得出。这种方法包括起始高剂量 5-ASA 治疗，然后在 2-3 周后评估症状改善情况。然后在需要时尽快引入类固醇，尽量减少延迟。通过这种方式，可以快速缓解症状，但许多患者可能避免了不愉快的副作用。
